Chesapeake Financial Services Application For Consumer Financing

DEALER NAME                                     CONTACT                        PHONE                        FAX
Applicant                                     SSN			Co-Applicant                                     SSN
Address			Address
City:                                State       Zip			City                                State       Zip
Phone#                    Years There             Birth Date			Phone#                    Years There             Birth Date
Previous Address			Previous Address
City                                State       Zip			City                                State       Zip
Present Employer                          Years There			Present Employer                          Years There
Address                                Phone			Address                                Phone
City                                State       Zip			City                                State       Zip
Gross Monthly Salary                   Position Held			Gross Monthly Salary                   Position Held
Previous Employer                   Years There			Previous Employer                   Years There
Address                                Phone			Address                                Phone
City                                State       Zip			City:                                State       Zip
Additional Income Source              Monthly Amount			Additional Income Source              Monthly Amount
Home: Own    Rent    Live With Relatives    Paid For			Home: Own    Rent    Live With Relatives    Paid For
Mtg. Co. / Landlord Name		Monthly Payment	Mtg. Co. / Landlord Name		Monthly Payment
Purchase Price	Current Balance	Market Value	Purchase Price	Current Balance	Market Value
Have you ever claimed bankruptcy or had any Federal Liens against you? Applicant    Yes    No / Co-Applicant     Yes    No
Are you a U.S. Citizen?     Applicant    Yes    No / Co-Applicant    Yes    No
By signing this application, you promise that all the information is true and complete. You intend the seller and/or assignee to rely upon these promises in deciding to extend credit to you. You authorize a full investigation of your credit record and your employment history. You also authorize the seller or assignee to release information about your credit. Signature_________________________________ Signature_________________________________
New     Used Year____ Make_______________ Model__________  Length_____ I/O  Outboard  Inboard Gas  Diesel Twin  Single Horse Power____________ Engine Make____________ Model_____________ Year___		Trailer    Yes     No Make ___________________ Length______   Axles______ Term requested ____Years New Invoice Amount ________ Used Book Value __________		Sales Price $____________ Taxes $_________________ Docs & Reg $____________ Warranty $______________ Total Sale $______________ Cash Down $_____________ Loan Amount $____________

 

Phone 877-787-6764     Fax 866-914-5560



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